Makindo Medical Notes

Behavioural difficulties in children are a frequent reason for concern in both families and schools. They may present as temper tantrums, aggression, defiance, inattention, or social withdrawal. In the UK, some difficulties are part of normal development (e.g. toddler tantrums), but persistent or severe patterns may indicate underlying neurodevelopmental, psychological, or social issues. 🌟 Early recognition and timely intervention improve outcomes and reduce long-term risks.

⚡ Attention-Deficit Hyperactivity Disorder (ADHD)

One of the most common behavioural disorders in UK children. Defined by inattention, hyperactivity, and impulsivity that disrupt home, school, and peer relationships.

• 🧩 Symptoms: Distractibility, fidgeting, restlessness, impulsive behaviour, poor task persistence.
• 💊 UK Management: CAMHS-led care under NICE NG87 – parent training, school support, and medication (methylphenidate, lisdexamfetamine, atomoxetine) when appropriate.

😡 Oppositional Defiant Disorder (ODD)

ODD involves persistent defiance, hostility, and irritability. Frequently overlaps with ADHD and typically begins in early school years.

• 🧩 Symptoms: Frequent arguments with adults, temper outbursts, blaming others, deliberate annoyance.
• 🛠️ UK Management: Parent training programmes (Triple P, Incredible Years), family therapy, consistent school-home behaviour plans. Early action prevents progression to conduct disorder.

🚨 Conduct Disorder (CD)

A severe disorder characterised by antisocial, aggressive, and rule-breaking behaviours. Strongly associated with poor educational outcomes, substance misuse, and offending behaviour if untreated.

• 🧩 Symptoms: Bullying, fighting, cruelty to animals, truancy, theft, fire-setting, vandalism.
• 🛠️ UK Management: Multisystemic therapy (MST), CBT, CAMHS referral. Severe aggression may require medication (e.g. risperidone) and social services involvement. Safeguarding concerns must always be considered.

🧩 Autism Spectrum Disorder (ASD)

ASD is a neurodevelopmental condition affecting communication, social interaction, and flexibility of behaviour. Behavioural challenges may arise from sensory overload, anxiety, or disruption of routine.

• 🧩 Symptoms: Poor eye contact, repetitive movements, strong attachment to routines, hypersensitivity to sounds/textures.
• 🛠️ UK Management: Speech & language therapy, occupational therapy, structured behavioural interventions, and Education, Health & Care Plans (EHCPs) for tailored school support.

⚠️ Risk Factors

• 🧬 Genetic: Family history of ADHD, autism, or mood disorders.
• 🏠 Environmental: Socioeconomic adversity, family conflict, trauma, inconsistent parenting.
• 🧠 Developmental: Speech/language delay, learning disability, perinatal complications.
• ⚕️ Medical: Epilepsy, sleep disorders, head injury.

🔍 Assessment in the UK

Assessment usually involves CAMHS, community paediatrics, or clinical psychology.

• 📚 History: From parents, teachers, carers, focusing on pervasiveness across settings.
• 👀 Observation: Direct behavioural assessment, play-based observation.
• 🧠 Developmental Testing: Cognition, language, motor skills.
• 📊 Tools: Strengths & Difficulties Questionnaire (SDQ), Conners’ Scales, Autism Diagnostic Observation Schedule (ADOS).
• ⚖️ Comorbidities: Screen for anxiety, depression, substance misuse, safeguarding risks.

🛠️ Management Strategies

• 👨‍👩‍👧 Parent Support: Evidence-based parenting programmes, consistent routines, clear boundaries.
• 🏫 School Interventions: EHCPs, specialist teaching assistants, behaviour support services.
• 🧠 Therapies: CBT, family therapy, social skills training, anger management strategies.
• 🎯 Behavioural Techniques: Positive reinforcement, token economy systems, structured time-outs.
• 💊 Pharmacological:
  • Stimulants (methylphenidate, dexamfetamine, lisdexamfetamine) for ADHD.
  • Atomoxetine or guanfacine for non-stimulant options.
  • Antipsychotics (e.g. risperidone) occasionally for severe aggression in CD/ASD, only under specialist supervision.

🚩 Red Flags

• Persistent aggression, cruelty to animals, fire-setting → urgent CAMHS/safeguarding referral.
• Self-harm or suicidal thoughts → crisis intervention.
• Marked developmental regression or sudden behavioural change → investigate underlying medical/psychological cause.
• Concerns about neglect, abuse, or domestic violence → safeguarding escalation.

📈 Prognosis

✅ With early recognition and support, many children achieve improved behaviour, academic attainment, and social outcomes. ⚠️ Without intervention, risks include school exclusion, offending behaviour, substance misuse, and adult psychiatric illness. 🌟 The earlier the support, the better the long-term trajectory.

✅ Conclusion

Behavioural difficulties are common, but persistent or severe patterns warrant structured assessment and multidisciplinary support. Collaboration between families, schools, CAMHS, and community services is essential. Early, family-centred interventions lead to better long-term outcomes 🎯.

📊 Comparison Table: Childhood Behavioural Disorders

Disorder	Key Symptoms	Typical Onset	UK Management	Prognosis
⚡ ADHD	Inattention, distractibility Hyperactivity, restlessness Impulsivity, poor task persistence	Early–mid primary school	Parent training School support (EHCPs) Medication (methylphenidate, dexamfetamine, atomoxetine)	Good with early support Some persist into adulthood
😡 Oppositional Defiant Disorder (ODD)	Defiance, hostility, frequent arguing Blaming others, irritability No serious aggression or rule-breaking	Early school years	Parent training (Triple P, Incredible Years) Family therapy School behaviour programmes	Can improve with consistent support Risk of progression to Conduct Disorder if untreated
🚨 Conduct Disorder (CD)	Serious aggression & violence Theft, truancy, vandalism Cruelty to animals, fire-setting	Later childhood–adolescence	Multisystemic therapy, CBT CAMHS referral Medication (e.g. risperidone) in severe aggression Social services if safeguarding	High risk of antisocial behaviour Increased risk of substance misuse & adult psychiatric illness
🧩 Autism Spectrum Disorder (ASD)	Social communication difficulties Repetitive behaviours Rigid routines, sensory sensitivities	Toddlerhood–early childhood	Speech & language therapy Occupational therapy Behavioural interventions EHCPs for education support	Lifelong condition Early intervention improves independence and social outcomes